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Insurance companies like to play doctor

On Sunday, Mike came into the kitchen with a piece of paper in his hands. He said, “Now, Julie, don’t freak out,” which, as we all know, is the universally accepted way to guarantee that whoever is about to receive bad news will be totally calm and collected. My body tensed up and I offered a wary, “Ooookaaaaay?”
The letter was from our insurance company, United Healthcare, cheerily telling me that in order to save money, they were no longer going to cover my Lyrica. The medicine my doctor prescribed for me to treat my fibromyalgia. The medicine that has made the difference between my ability to walk or not. BUT! Not to worry. I would have the “opportunity” to try other lower-cost alternatives now! Once I sampled at least three drugs from a veritable buffet of pharmaceuticals, I could then be allowed to resume taking Lyrica.

I began sobbing. Once again, the insurance company presumed to know better than the doctor and the patient. Profit shares were more important than patients. While my body isn’t in perfect condition, I have finally reached a point where my functionality, pain, and energy are better than they’ve been in a long time. A combination of physical therapy, acupuncture, therapy, and a truckload of medicine and supplements fit together in a Jenga tower of healthcare for me. If one piece is removed, everything will come crashing down. Additionally, Lyrica causes weight gain for patients genetically predetermined to gain weight on such medications, like me. The last time I went off Lyrica to try gabapentin it was an abysmal failure. The more I took, the more pain I experienced, to the point of not being able to touch my feet to the floor, let alone walk. So back on the Lyrica I went. My body went, Oh, gee, this is a new drug that’s telling me to give Julie an additional 20 pounds. To try and fail with another drug would guarantee more weight gain for me, making my body virtually untenable.

I looked at the list of drugs I needed to try. It was laughable to me. If ever there needed to be more evidence that so many believe fibromyalgia to be all in the patient’s head, this list of drugs proves it.

1. Cymbalta
An anti-depressant that I’m already taking. While it is a drug that is specifically marketed to help with pain caused by depression, it stopped managing my pain within a few months of beginning the medication. Anecdotally and according to doctors with whom I have spoken, this is common with Cymbalta.

2. Gabapentin (commercially, Neurontin)
It does work for some, but you have already read how it worked out for me.

3. Effexor XR
An anti-depressant. I’m already taking an a anti-depressant. Two, actually. I don’t need a third. It can be used off-label to treat diabetic neuropathy, but medications that are actually meant to treat that condition are preferred.

4. An anti-depressant, like amitriptyline
Again with the anti-depressants! Oy! Depression doesn’t cause fibromyalgia; fibromyalgia causes depression. Wouldn’t you be a tad bit depressed if you were in constant pain, knew you were going to be in constant pain for the rest of your life, and could no longer participate in life the way you once did because of your pain and fatigue? This is also a potential off-label treatment drug but, again, I don’t need a third anti-depressant.

5. SavellaWhat’s the problem with Savella?, you may ask. After all, it’s a drug that specifically treats fibromyalgia. Here’s the thing. I am in fibromyalgia forums where people ask about experiences with Savella all the time. Out of the hundreds of people who say they’ve been on Savella, two have had a good experience. Two. Noooooow, I’m not a bettin’ woman, but those don’t seem like terribly good odds. One of the bad side effects of Savella is terrible nausea. I am a complete pussy when it comes to nausea. Give me pain any day over even the slightest bit of nausea.

Once I was able to pull myself together, I began Twitter-shaming United Healthcare as quickly as my brain could think and my fingers could type. On Monday, once I explained that trying new medications is not like sampling ice cream before you choose your cone, I was given the prior authorization number for my doctor to call, (which was conveniently left off of the letter) to tell insurance that I need to be on Lyrica. Because the prescription wasn’t enough.

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9 thoughts on “Insurance companies like to play doctor”

Insurance companies suck. I’m glad you were able to get authorization to bypass their ridiculous gauntlet of hell. Cycling through a bunch of medications like that is sure to cause long-term problems for anybody who tries it.

I hear you LOUD. and CLEAR on the insurance companies. I’ve been on an incredibly low dose of Lyrica; 150 mg per day as I get myoclonic jerks if I start taking over 250-300 mg. When my DOCTOR suggested going up to 225 mg as I was experiencing increased pain, my insurance company, Blue Shield PPO (private insurance which I’ve had since I was 25; I’m 48 now) said NO to adding one more 75 mg Lyrica pill, I had to call my doctor and get HIM to tell the insurance company why I needed to increase the dosage. Also, Lyrica is the only drug I’m on where, even WITH insurance, I have to pay $225 a month for it because the pharmaceutical company has been in a fight to the death to keep the patent on it. Even Cymbalta went generic (I had the exact same response to Cymbalta that you did BTW). I LOATHE insurance companies with every fiber of my being. Don’t get me wrong; I’m incredibly grateful to even have insurance but aside from the pharmaceutical industry, I truly can’t decide who is greedier and more evil. I’m glad it ultimately worked out for you. Every time I get anything from Blue Shield in the mail my heart skips a few beats. It’s wonderful to be sick AND live in fear.

the good news is that since you’ve already tried most of these the doctor should just be able to show proof that you have and get the insurance to approve the drug you are already taking. One other thing to mention is the difficulty coming off of Lyrica and the time it would take.

As for the anti-depressants, I think people get really hung up on those for the wrong reasons. They are used because they work on certain neural pathways in our brain that result in pain, not because they think that we are just depressed.